A 3-Step Guide of 4M Thread Lift Technique for Facial Rejuvenation

The use of thread lifting during surgical face rejuvenation has grown in popularity. It is required to carry out both soft tissue envelop repositioning and volume restoration operations to successfully rejuvenate an aging face. Surgeons have kept evolving their approaches in response to the trend for less intrusive procedures and long-lasting effects with lesser complications.

A study done by Dr. Young Jin Park, Dr. Jong Hyun Cha, and Dr. So-Eun Han, developed the 4 M thread lift technique for long-lasting results—Multi-target, Multi-vector, Multi-layer, and Multi-material. The 4 M technique entails multiple layer lifting and rejuvenation employing diverse materials in addition to several targets. Its thread lifting approach demonstrated little to considerable improvements using the principles of structural rejuvenation, sustaining satisfactory outcomes a year after the treatment.

First Step: Deep Layer Approach

The first entry point of the thread was located along the hair line, where the inferior temporal septum is located, and usually above the lateral canthus. Upon entry, the long cannula penetrated the zygomaticocutaneous ligamentous region and the masseteric cutaneous ligament and finally ran lateral to the risorius muscle fascia the corner of the mouth.

For the deep SMAS layer and reticular cutis, a PDO 18G 3.0 USP 100 mm was used on either side for upward lifting and suspension as well as lateral oblique suspension. This led to the formation of jam wrinkle, which is a reduction in skin elasticity, caused by squeezing of soft tissues.

To lift the lower facial skin of the mandibular border and to obliquely lift the loose ligamentous lateral structures, another insertion of the thread was performed in the mandibulocutaneous ligament. The other one is usually placed between those two across to the marionette line and above the depressor lower lip muscle fascia.

Medially, another lifting was performed using 2 pieces of thread from the lateral to the nasal base that had dense maxillary cutaneous ligaments and dense fibrocutaneous ligamentous parotid masseteric fascia.

A medial oblique lifting vector played a role in both anterior cheek augmentation and the maintenance of lateral oblique suspension from jowl to the temporal area. A medial oblique and lateral oblique insertion of a total of 5–6 threads was performed in the deep tissues, including SMAS and septal structures as the reticular cutis.

Second Step: Middle Layer Approach

For greater volume enhancement and adhesion, it is also preferable to perform a lifting in the middle layer. In patients with reduced skin elasticity, even after 19G, the 21 or 23G PDO USP 2-0 100 mm thread was used in the subcutaneous layer to maximize squeezing and foreign body reactions.

For structural enforcement, 2 pieces of PDO 21G 2-0 USP were placed along each side of the midcheek groove around the zygomaticocutaneous ligament. In addition, 2 pieces of PDO 23G 4-0 USP were vertically placed along the mandibulocutaneous ligament lateral and vertically.

This step was then followed by a third envelop rejuvenation step, which involved strutting and the provision of a physical support using 10–20 screws of 27 or 29G USP 5-0 on each side.

Third step: Superficial Layer

In the last step, the rejuvenation effect was maximized on the jam wrinkles and jowling using 15–30 pieces of 27 to 29G USP 5-0 mono-threads. It is technically challenging to inject a mono-thread that extends to the dermis in the skin layer, as it might lead to the formation of fibroblasts in the subdermis layer. As a result, a technique that uses numerous mono-threads under the dermis was employed for skin rejuvenation.

For maintenance of the lift after completion of the procedure, a paper tape splinting was recommended for at least 8 h. For the purpose of evaluation of the results, the patients were followed up regularly for a postoperative duration of 2 years.

Conclusion

Improvements in the surface area to volume ratio are regarded as the most effective antiaging techniques since aging is a phenomenon in which different tissues are weakened and collapse in diverse directions rather than just soft tissue or skin drooping due to gravity.

The 4 M thread lifting method retains the principles of face-lifting, repositions aged tissue back into its original location, and lifts several layers of the structures overlying the tissue. For the best results, physiologically drooping tissues should be lifted using thick cog threads, the middle layer should be lifted using appropriate threads, and the epidermal layer should be treated using the concept of structural rejuvenation.

That is why we proposed multiple layer lifting and rejuvenation using different materials and multiple targets, including the periorbital, midcheek, jawline and neck line areas. It is meaningful that 4 M thread lifting concept of structural rejuvenation of aging tissues are introduced and evaluated the sustained effect of this method in this study.

Reference

Maximizing Thread Usage for Facial Rejuvenation: A Preliminary Patient Study (2020)

Non-Traditional and Non-Invasive Approaches in Facial Rejuvenation: A Brief Review (2020)

Clinical Application of Three-Dimensionally Printed Biomaterial Polycaprolactone (PCL) in Augmentation Rhinoplasty (2020)

The Facial Fat Compartments Revisited: Clinical Relevance to Subcutaneous Dissection and Facial Deflation in Face Lifting (2019)

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